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The marathon was invite-only via an application process. Before BNAT 5 in 2003, there were typically two ways to gain admittance – one for Austin residents that usually involved some event (such as BNAT 4 in 2002 having a costume contest at a horror movie screening at an abandoned mental institution on Halloween), then a separate one for those not in the Central Texas area. After BNAT 5, the application process was changed to internet-only involving several essay-style questions and submissions of pictures, which is then used to create a yearbook with all the registered attendees. Competition to get in was fierce, as 10,000 or more applicants attempt to gain one of the approximately 200 seats. This system was put into place to ensure that only die-hard film fans would be in attendance as well as to be fair, as attendance is limited to the seating capacity of the Alamo Drafthouse.

While BNAT was home to numerous special screenings and celebrity guest appearances, as much or more significant to explaining the thrust and tone of this event is the many other movies that have been screened, as well as the unique impact of seeing 12-13 films and 30-40 vintage film trailers back-to-back over a 24-hour period without ever leaving the confines of the movie theater. For every premiere or widely known classic that was shown, there was a forgotten gem, a tiny independent work, a foreign title or a film that was unlikely to receive a public screening in any other venue due to content that would generally be considered perverse, disgusting or a reflection of cultural sensitivities no longer considered acceptable.

BNAT was characterized by such novel surprises as having a live jug band accompaniment to Buster Keaton's silent classic The General, the delivery of fresh meat pies to attendees during the early screening of Sweeney Todd, shot glasses of caviar and vodka given to attendees to mirror a scene in The Curious Case of Benjamin Button, and the use of electrically shocking devices to zap sleeping audience members during an intentionally interminable 3:00am viewing of 1950s creaker-classic Attack of the Gila Monster.[citation needed]

Butt-Numb-A-Thon was held annually in Austin, Texas, for the first eight years at the Alamo Drafthouse's (now closed) original downtown location at 409 Colorado St. In 2007, BNAT 9 was held at the Alamo Drafthouse Ritz location at 310 E. Sixth Street. After 2008, the festival was held at the Alamo Drafthouse South Lamar at 1120 South Lamar Boulevard. BNAT 15 in 2013 was held at the Alamo Drafthouse Ritz location while the Alamo Drafthouse Lamar underwent renovation.

On June 24, 2007, as an acknowledgment of the last days of the Alamo Drafthouse's original downtown location, Harry Knowles hosted a hastily assembled half-birthday marathon titled "Half-Ass-A-Thon". Half-Ass-A-Thon was to initially only show four features, but by unanimous vote of the audience the marathon was extended to five features.

Following revelation a few days prior of allegations of sexual assault and sexual harassment against Knowles, the Alamo Drafthouse, which served as the venue for BNAT, announced on Sept. 25, 2017 that it was cutting all ties with Knowles[2]. Knowles himself stepped down from contributing to his website Aint-it-cool-News in the aftermath of the charges[3]. In the weeks leading up to Knowles' birthday in 2017, no plans for BNAT at an alternate venue or event plans had been announced, as had been the case in past years.
Knowles' Dec. 11 birthday passed in 2017 without a festival taking place or any statement on 2018 plans, leaving its future in doubt.